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Ortiz Law Firm | National Disability Law Firm
Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual disability insurance policy claims, ERISA disability claims, and Social Security Disability claims.
Under the arbitrary and capricious standard, the review is limited to whether reasonable grounds existed to support Aetna’s denial of benefits based on the administrative record before it. The Court held that Aetna reasonably concluded that Plaintiff was no longer entitled to long-term disability benefits and that their decision process was neither …
The Court found Aetna’s denial of Plaintiff’s claim for long-term disability to be arbitrary and capricious and ordered Aetna to pay the long-term disability benefits for which he is qualified under the Plan.
Aetna approved the Appellant’s claim for LTD benefits from September 25, 2012, through February 23, 2013, but denied her claim for benefits for any period thereafter. Thus, the Sixth Circuit limited its review to determining, de novo, whether the Appellant was entitled to benefits beyond February 23, 2013.
Melissa McIntyre (“McIntyre”) worked as a Mayo Clinic Health System nurse. She was covered under a long-term disability plan which was administered by Reliance Standard Life Insurance Company (“Reliance Standard”). Around 2011, McIntyre’s health caused her to cease working. McIntyre suffered from Charcot-Marie-Tooth Syndrome, a neurological issue …
In the present case, Brenna Mawa (“Mawa”) worked as a nurse, Branch Director, and Clinical Director; she was employed by LHC Group, Inc. (“LHC”). The company was insured by a Group Long-Term Disability Plan for Employees issued by the Hartford Life & Accident Insurance Company. This plan defined a disability as whether a person can perform the …
Marcia L. Smith (“Smith”) worked as a property manager for Arlington Properties, Inc., and starting on March 1, 2016, she was covered under a long-term disability plan administered by United of Omaha Life Insurance Company and Mutual of Omaha Insurance Company (collectively, “United”). The plan provided the following as part …
Here, Melissa Maher (“Maher”) was Manager of Research and Development at Bonne Bell, L.L.C. (“Bonne Bell”). Her job duties were considered to be light with sedentary demand. Further requirements were the ability to use ten pounds of force and other exertions of lesser amounts more frequently. Because of her employment with Bonne Bell, Maher was …
Case Name: Leonor v. Provident Life and Accident Company and Paul Revere Life Insurance Company Court: United States Court of Appeals for the Sixth Circuit, on appeal from the United States District Court for the Eastern District of Michigan Type of Claim: Long-Term Disability Insurance Companies: Provident Life and Accident …
The Complaint alleged that Reliance made the final decision to deny Lash’s claim. The claimant failed to state a claim against Matrix is granted.
The present case involves an ERISA claim for short-term disability and long-term disability insurance benefits where the claimant argues that the administrator improperly denied his claims for benefits. Marc Kouzmanoff (“Kouzmanoff”) was a sales representative for Thompson Reuters Holdings, Inc. (“Thompson Reuters”). In 2001, he developed diabetes; …
In this case, the court found that United of Omaha Life Insurance Company failed to evaluate the medical evidence presented adequately. The insurer ignored favorable evidence submitted by her treating physician(s), selectively reviewed the evidence it did consider from the treating physicians, failed to conduct its own physical examination, and …
The Court held, “The level of activity or the lack thereof that Mr. Khalil reported to Liberty in support of his claim of continued disability was undermined by the video evidence that Liberty collected during the three years of review.” The claimant’s claim was further undermined by the fact that his own treating physicians ultimately opined that …
On May 8, 2015, United informed Kerridge’s counsel by letter that it had denied Kerridge’s appeal. United indicated that its decision was based on the records from Dr. Wilson and the Cleveland Clinic, the other records in Kerridge’s file, and Dr. Zafar’s report from the IME. Kerridge filed a civil action in Federal Court seeking review of United’s …
In this case, Kenneth Baker (“Baker”) was an employee who worked for Dunkin Donuts. Through his employment there, he held a policy for long-term disability benefits. Unfortunately, Baker lost all of his administrative appeals with the insurance companies. He also lost at the lower Federal Court. The opinion below relates to Baker’s appeal of the …
Here, Kelly Ann Tyler (“Tyler”) filed a claim for a breach of disability insurance contract against United States Life Insurance Company and American General Life Insurance Company (together, “American General”). Further, she filed claims for a breach of the covenant of good faith and fair dealing by American General, seeking punitive damages. …
Katherine Kochanek (“Kochanek”) worked as an employee of Home Depot U.S.A., Inc. (“Home Depot”). Through her employment, she was covered by the Home Depot Welfare Benefits Plan which included short term disability benefits. Aetna Life Insurance Co. (“Aetna”) served as the administrator of the Plan. Under the Plan, a “disability” is considered to be …
The fact that Dee was eventually diagnosed with cancer and that her shoulder pain “in retrospect” was caused by her cancer is not material to a determination of whether her medical care providers at the time of the medical treatment suspected cancer.
Lisa Jones submitted a claim for long-term disability benefits under an LTD Plan provided to her by Boeing. Aetna was the plan administrator; Aetna denied the LTD claim. Ms. Jones sued under the Employee Retirement Income Security Act (ERISA) for denial of benefits and breach of fiduciary duty. The district court (lower court) dismissed the …
Jennifer Coats (“Coats”) was employed by Cottage Health Care as a staff nurse. Through her employment, she was able to participate in an employee welfare benefit plan which included coverage for long-term disability benefits. These benefits were funded by Reliance Standard Life Insurance Company (“Reliance Standard”). More specifically, Reliance …
The court agreed with Doe that Standard's reliance on the DOT description of a generic "lawyer," rather than a job description that fully and accurately encompassed the material duties of Doe's specialized area of legal practice, rendered Standard's decision arbitrary and capricious.
The Second Circuit recently ruled in favor of Hartford in a long-term disability claim involving multiple sclerosis, finding that Hartford's denial of long-term disability coverage was not arbitrary and capricious.
The Court affirmed the district court’s decision granting summary judgment to Reliance Standard on the ground that it did not abuse its discretion in denying the claimant’s long-term disability benefits. In other words, the Court ruled in favor of the insurance company.
The court ruled that Hartford reasonably relied on medical opinions and surveillance evidence in deeming her ineligible for continued benefits, which means Hartford’s decision to terminate LTD benefits was rationally justified and thus is not arbitrary and capricious.
The judge stated that, "the record, the policy, and the Parties’ arguments do not support the assertion that Plaintiff was disabled as of July 2012 (termination of LTD benefits) and August 2012 (termination of LWOP benefits). The Court, therefore, has no alternative other than to affirm Unum’s decision to deny Plaintiff’s benefits.”